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CAREERS

Hours 2324 Centerville Road
Tallahassee, FL 32308

Surgical, Anesthesia, and Treatment Consent Form

Thank you for filling out our Surgical, Anesthesia, and Treatment Consent Form.

Patient Name:*

Species:*

Breed:*

Sex*

Age*

What time can we call for status, lab results or financial updates?
*(Anytime, between certain times, etc)**

Code Status

Please initial next to a choice*

CPR
DNR

I hereby certify that I am the owner of the above-named animal or I am responsible for it and have the authority to execute this consent.
I hereby authorize the use of such anesthetics as you deem advisable and the performance of such surgical or therapeutic procedures as you determine to be indicated.
I agree to indemnify and hold Allied Veterinary Emergency Hospital harmless from and against any and all liability arising out of the performance of any of the procedures referred to above.*

I agree to all of the above

Surgical Deposit may be required upon submission of signed paperwork.

Please take all belongings with you. We are not responsible for lost or damaged personal property that is left behind. Any belongings left behind are subject to immediate disposal at the time of discharge.
Type your name*

Allied Veterinary Emergency Hospital